I am thrilled to announce that I will be introducing a new vaginal laser treatment as an outpatient procedure this fall at Houston Female Urology. As the first urologist in Houston who’s taking advantage of this groundbreaking technology, I can’t wait for my patients to reap the benefits! Meet the MonaLisa Touch.
The MonaLisa touch is a treatment aimed at combating vaginal atrophy. Vaginal atrophy may be caused by hormonal changes during menopause, and it may also occur in women who experience a decreased estrogen production due to cancer or breastfeeding. Thinning, drying and inflammation of the vaginal walls are typical characteristics, and it may cause intercourse to be painful and contribute to problems with urination.
My patients who experience these symptoms will now be able to restore youthful, trophic conditions in the vulvo-vaginal area with the MonaLisa Touch. The MonaLisa Touch is a minimally invasive laser method that is completely reliable. Its CO2 laser source emits an impulse, and the method does not trigger negative effects like some hormone-based therapies.
Often during the period of menopause, the vagina is subject to a loss of swelling and hydration of tissues, which may cause discomfort for many women. As I mentioned earlier, some of the symptoms include itchiness, dryness, burning, loosening of the vagina and pain during sexual intercourse. Not only do these symptoms cause discomfort, but they can also interfere with your quality of life.
I am excited about the MonaLisa Touch because it naturally and painlessly overcomes vaginal atrophy by triggering physiological processes that eliminate signs of aging. Most importantly, the treatment brings an improvement in physical conditions that enable women to feel like their vulvo-vaginal areas are aging in reverse.
Stay tuned as we share more information throughout the coming days and weeks about the MonaLisa Touch. I think you’re going to love it!
Before I became a PA, I used my Master’s degree in Psychology to work with the severely mentally ill. During this time, I learned that everyone has a story to tell.
While training in PA school at Saint Louis University, one of my instructors told our class that the most crucial part of an appointment is taking an accurate history and knowing what questions to ask. After this, you need to allow the patient to talk, because they will often give you the diagnosis.
Throughout my 10 years as a PA, I have used the skills I acquired in these two learning environments to encourage my patients to tell their story and chronicle the events that led up up their appointment.
During their story, I only interrupt at a minimum to verify my understanding while collecting pertinent details. When the story concludes, I typically only ask a few additional questions to fine tune an accurate history.
If I don’t have a diagnosis by this point, I’ve at least narrowed down to a handful of possibilities before conducting the physical exam and ordering labs, imaging and office procedures.
Make no mistake, I realize that listening is a skill that takes time, patience and practice to hone. As the provider, you must train yourself to quiet your thoughts and remain in the moment with the patient. Remember those seemingly insignificant details, because you often must make inferences and deductions. Lastly, you need to listen to what they are not saying.
This process takes a little longer than other methods. However, the clear benefit is that fewer delays are encountered while developing an accurate diagnosis. The end result is that the provider initiates an effective and appropriate treatment more quickly, which leads to better outcomes for the patient.
– KIM BREY, PA-C
“Tomorrow morning at 8:00 we will have the ribbon-cutting and then start the actual business of seeing patients, ready or not! At this point, I can only pray that God will bless this practice, as I use the gifts, talents and passion that He has given me to bless the people that walk through our door. Tomorrow starts the next chapter of my life!”
This excerpt is from my first blog entry. I wrote this the day before I prepared to open the doors and welcome patients into my brand new practice. I was feeling so many emotions! Excitement, stress, peace, fatigue, joy.
I took a big leap of faith, and looking back on the past year in private practice, I see God’s blessings in every area of my personal and professional life.
This month marks a huge milestone for me. I’ve successfully made it through one year in this new chapter of my life. It is important for me to stop and reflect on my influencers and supporters and share my thankfulness to so many people who have made this year possible:
I’ve built such a wonderful, thoughtful and knowledgeable team of women around me! They have supported me every step of the way and have truly caught the vision for what we are doing here. Patients truly see a difference when they come to the office. I get comments from patients almost daily that they have never been to such a great doctor’s office where everyone is helpful and cares about them. I’m so proud of each one of them.
MY REFERRING DOCTORS
I am so thankful every day for the valuable relationships I’ve fostered throughout the years with Houston-area doctors. These colleagues have supported my practice and believed in my team to provide quality urological care as they refer their own patients for us to take care of. We do not take it for granted and strive to provide great service at all times.
I have learned so much from other physicians who are further down the path than I am. They have been so generous to share their wisdom and insight. There are many pieces that have to fit together when you start a new practice, and my mentors have been great to help me put it all together.
I owe so much to my loyal patients. These women have trusted me and my team to provide solutions for their urological needs, and I am always blessed by their kind words, success stories and commitment to Houston Female Urology. You are the reason I am here, and I hope to continue to earn your trust and loyalty for many more years to come.
Most importantly, my family has stood beside me through thick and thin. They have shared in my successes and encouraged my spirit. None of this would be possible without my amazing husband and two children! They have been great cheerleaders while I have embarked on this endeavor.
This journey is only beginning…I have so much to look forward to throughout the coming years! I can’t wait to continue to develop and grow Houston Female Urology as we seek to provide expert medical advice, life-changing procedures and uncompromised personal care to every woman who walks through my door.
From the bottom of my heart – thank you.
Yes, there is a day or a week for just about everyone and every cause these days! But this one is near and dear to my heart, because I see women every day whose lives are affected negatively by incontinence. Fortunately, I also get to see how their lives are greatly improved by our treatments. World Continence Week is an annual initiative with a primary goal of raising awareness about issues related to bladder control. You probably know that incontinence is the involuntary leakage of urine, but did you realize that bladder control problems are preventable, and they can be managed and often cured?
This is a hard topic for many people to talk about, and believe me, I completely understand. Of all the medical issues that women talk about with their friends, for some reason, they do not want to talk about this issue. Some of my patients even hide it from their husbands. Incontinence is a sensitive subject, and it affects an estimated 400 million people around the world.
Because this sometimes feels too taboo to discuss, World Continence Week has stepped in to draw attention to the problems and increase awareness about the condition. At the end of the day, this week is about giving a voice to those who suffer while boosting their confidence to seek help from a doctor and improve quality of life.
I want you to know that if you are suffering with incontinence issues, or you know someone who suffers, you can start the process today to begin changing your life for the better. Here are three easy steps that you can begin right now. I have found these to actually be curative in some cases.
There are many other options to consider in your journey to treat and cure incontinence. I have created a bladder treatment pathway to make it easy to see the various treatment options and guide you most quickly to the therapy that will work for you. We can discuss the best route for you during a visit to my office. My staff and I talk about this every day, so leave your embarrassment at the door! We are here to care for you and walk beside you as we tackle this issue.
We can discuss:
Take action this week! I promise it’s worth it. It can literally change your life.
Botox is well known for its cosmetic purposes. If we’re honest, the first thing that comes to mind for most people is a procedure that targets and relaxes facial wrinkles. Fortunately for those suffering with urinary incontinence, Botox can also provide a powerful answer for this problem. This can be treated with an injection in the muscle of the bladder to ease the symptoms of an overactive bladder.
The New York Times recently conducted an in-depth report on incontinence. The study found that, “About 20 million American women … have urinary incontinence or have experienced it at some time in their lives. The number, however, may actually be higher because most patients are reluctant to discuss incontinence with their doctors. In fact, research indicates that many patients will not admit to having the problem even when questioned directly.”
As a urologist who exclusively treats females, the last thing I want is for my patients to feel like they have to stay quiet and learn to live with this condition. I’m always pleased to tell women about bladder Botox and the relief and freedom it provides. I understand that this is a tough topic to approach for many, but my team at Houston Female Urology handles this discussion with empathy, care and kindness.
Bladder Botox is a quick in-office procedure that is well tolerated by our patients. The treatment begins by flushing the bladder with a local anesthesia through a catheter to numb the bladder. Then a scope is passed up the urethra into the bladder, and a small needle is placed through the scope where several injections are made to spread the Botox throughout the muscle of the bladder. This significantly relaxes the bladder, and my patients are able to return home on the same day of the procedure.
The Botox begins to work at about one week with its full effects beginning at two weeks. While this procedure is not permanent, it lasts approximately six to eight months when injected in the bladder. There are no limitations to the extent of use, and my patients are so happy with the results I tend to see them once or twice each year for Botox injections.
One of the best parts of my job is bringing hope to women who often silently struggle with urology issues. It’s so rewarding to see my patients’ faces when they see the light at the end of the tunnel after Botox – they have their lives back.
It has been a long time since I wrote in my blog. The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me. I started this entry right before Thanksgiving.
As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can. Now, I often fail, but it’s a striving and a focus that informs my day to day living. I don’t think that we have a “spiritual life” and a separate “secular life”. I think it is all integrated. As such, when I come into an exam room or the operating room, I am thinking “What is God doing here? How can I join in with His work?” Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.
I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced. Now I follow the leading of the Spirit. When I feel that I need to pray or ask probing questions, I do it. It is amazing how God answers, often in ways I didn’t expect. Just the other day, I prayed with a patient who had just found out she had rectal cancer. I could see that she needed the comfort of knowing that God will be with her in her fight.
Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it. I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery. Most patients are very grateful for the prayer. Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.
I have some examples that show how God has answered prayers in my practice and in my life. One day the robot at the hospital broke down before my case. That was just one of many things that had happened that day. There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues. But it was really stressful on me, because things weren’t going smoothly. I just continued to lean on the Lord and pray for my patients and for our whole surgical team. One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone. Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her. But the Lord gave her amazing peace. She is now several weeks postop and doing great.
Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone. This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated. I was also concerned because I thought the bladder had partially ruptured when I was using the laser. When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan. I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient. Well, the open surgery went about 500% better than I had expected: there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone). Another answered prayer! She recovered beautifully and is doing better than ever.
Not only do I pray for my patients, but my staff does, too. We all get to participate in what God is doing. He cares about every part of our lives, even our urological health!
I have always been so thankful for the privilege of being a doctor and specifically a female urologist. I hope that God is honored in my service to my patients. I am humbled for the opportunity.
Urinary tract infections (UTIs) are some of the most common conditions that we see in our office every day. Almost every woman will have an infection at some point in her life. UTI is a catch-all term that means an infection anywhere in the urinary tract, which in women could mean kidneys (pyelonephritis, characterized by fever) or bladder (also called “cystitis”, with typical painful urination, frequency, urgency). We often use “UTI” and “bladder infection” interchangeably.
They seem to occur at times of hormonal or sexual change: a young teen starting her period is more prone, a honeymooner beginning to be sexually active, a woman going through or who has gone through menopause. The vaginal pH is very sensitive to estrogen and when that pH is out of whack, the bacterial balance gets off kilter and a UTI is more likely to occur.
UTIs also occur when the body is stressed, either physically or mentally. The immune system is weakened and the normal barriers to infection are not as strong. We see this a lot: after surgery, when a husband dies, or work is super-busy patients are more likely to get infected.
But usually they occur for no good reason at all. As women, we have naturally short urethras (the tube that goes from the bladder to the outside), and bacteria are always getting in there. If we are flushing them out and the local area is healthy, then we don’t get infected. When there is a compromise in the system, we tend to get infected.
What are the natural immune barriers? Well, first of all, if you are overall healthy and exercising, not smoking and taking care of yourself in general, then the blood flow to your pelvis is good and that makes the whole area healthier and able to function normally. Drinking plenty of water to stay hydrated and to flush the bladder regularly will wash out any bacteria that are trying to take an opportunity in the bladder. The bladder itself has a natural layer of glycosaminoglycans that protects the bladder wall from infection. These are the fundamental blocks to infection.
When a patient comes in with recurrent UTIs, we will ask about their fluid intake, sexual correlation, other health issues, surgeries in the area, and menopausal status. We will do a thorough examination of the pelvic area, including measuring how much urine is left behind after voiding to make sure the bladder empties well. And we will look at the urine under the microscope.
If someone has more than 3 UTI in a year, then we will look more in depth: renal ultrasound to look at the kidneys, x-ray to look for stones and a bladder scope (cystoscopy) in the office to evaluate the bladder wall. Sometimes we will order a CT scan if there has been blood in the urine.
Some other causes of recurrent UTI that we are looking for: urinary stones, urinary obstruction, and although unlikely, bladder tumors. In thousands of scopes for UTI, I’ve found two tumors, but I sure wouldn’t want to miss one.
So drink your water, exercise to keep that blood flowing and to help manage stress, and eat lots of fruits and veggies. And hopefully you will be able to stay away from the urology office!
Did you know that women are just as likely to get kidney stones as men??? I don’t know why, but there is a perception that women don’t get stones as often as men. But we all have two kidneys, which is where stones originate.
Stones are literally just that: rocks. If you have never actually seen a kidney stone, they look exactly like rocks. They are made of minerals that crystallize in the kidneys and then conglomerate together to form a stone. As long as the stones are sitting up in your kidney, they usually don’t cause any pain. But if they decide to pass and start heading down the urinary tract, look out. It is the worst pain that humans endure. Women who have had natural childbirth and have a passed a kidney stone will tell you that they would much rather have a baby any day!
You do not want a kidney stone! As much as a I love stone surgery (laser surgery is like playing a video game, all that time playing Ms. Pac-man is paying off now, Mom), I know you don’t want to have to go through that. Here’s how to prevent them:
If you have a family history of stones, you are more prone to get one yourself, so get on this! If you have ever had a stone, you have a 10% chance each year thereafter that you will get another one.
Be healthy and hydrated!!
I want to let you in on a little-known therapy that can really help you with your bladder control issues. No medications to take with side effects. No surgery. Whether you leak with urgency (that “gotta-go” type) or stress (cough, exercise), or both, this is the place to start restoring urinary control. Even if you just have overactive bladder or get up too much at night, this therapy is great for you. You don’t hear about it as much since it is not offered very many places and there is no drug company to spend millions advertising it.
It is called Pelvic Floor Muscle Training. I tell patients that it is sort of like a personal trainer for your bladder. And it really does work. Of course, it’s not 100% effective for everyone, but most patients will get dry or almost dry with this therapy.
So, what it entails is coming in for therapy once a week or every other week for 4 – 8 sessions. My pelvic floor specialist will help you out. What she will do is gently place a small tampon-like probe in the vagina and a smaller one in the rectum. She will then assess your strength by having you do Kegel’s exercises. If you don’t know how to do them, then she will teach you. After that phase is over, she will take out the rectal probe, and move to stage two with the vaginal probe only.
The vaginal probe provides electrical stimulation which will boost muscle growth and reset the bladder nerves so that they will calm down. This takes about 8 – 15 minutes. The whole thing is about 40 minutes the first time and 20 minutes on follow-up. Throughout the session, my pelvic floor trainer will talk to you about other strategies to help you with your bladder control issues. Once, we found out during therapy that our patient that was drinking 6 Diet Cokes per day and once she stopped it, her bladder issues resolved.
Then, there is homework. She will write a plan for you to work on Kegel’s to get you in the habit of activating those muscles and strengthening them. The more consistent you are with the exercises, the better you will do.
This therapy has been proven effective in multiple studies. It is covered by most all insurance carriers and Medicare. In fact, oftentimes, the insurance company will require that this therapy be tried before moving on to advanced therapies. It works in two ways: strengthening the pelvic floor and resetting the bladder nerves.
Pelvic Floor Muscle Therapy is particularly good to do postpartum. The muscles are so weak and stretched out after having a baby, that it will really help you get back to normal more quickly if you have a few sessions to strengthen the muscles again. That will prevent a lot of trouble down the line. Insurance will cover that as well.
Then, after the therapy is over, you continue the exercises and if you are interested we can set you up with a home therapy device that you can use yourself.
It’s a great way to get the pelvic floor toned up with great bladder control!
Have a wonderful day,
It is 8/8/14. We opened our doors 7/7/14, so that means we have one month under our belt!! Woohoo! We did it/are doing it! Things are coming along very well. We have helped almost three hundred ladies with their urological issues so far and have registered almost 400 into our system for appointments. We’ve started doing surgery through the new practice: some bladder repairs and a few stones. And our pelvic floor program is in full swing. We have been busy!
I truly feel blessed. This is the realization of a dream that I have had for many years: to have a urology clinic for women and to have my own practice. It is so fulfilling. Everything is the way that I have envisioned it: a beautiful, calm, clean office where patients can feel assured that they will be treated gently and professionally. My staff is amazing. They have put their heart and soul into this start-up and they truly see this as a mission to help women and not just another job. I am so proud of them. And, we have a lot of fun together!
There are of course, moments of doubt. These are brief moments, but a frustration will occur and I will think, “what have I done?!?” Gulp. But in those times, I stop and think, “Christi, remember who is in ultimately in control here. Who has orchestrated everything to make this happen? Who has paved the way, given you the desire to be a doctor since you were three years old, opened up and closed the right doors along the way? God has got you, and He has your practice, too. The whole thing is squarely in His strong hands. Rest. Don’t worry. This is His practice.” He gives me a strong peace and courage to continue forward. It’s all going to be good.
So, I am incredibly blessed and thankful and peaceful about this adventure. Life is too short not to make big moves and walk by faith! If I weren’t a Christian, I would be a wreck, I think. But knowing that God has already paved the way and having His peace, I can relax. I can just lean on Him and go step by step. He has placed me here at this time, and my job is to trust Him and share the love of Christ through urology!